Mood Disorders: Depression

Chapter 12

Defined as a depressed mood or loss of interest that lasts at least 2 weeks & is accompanied by symptoms such as weight loss & difficulty concentrating

Prevalence & Comorbidity 4th leading cause of disability in US Projected to be 2nd leading cause disability by 2020 Frequently accompanies other psychiatric disorders Mixed anxiety-depression most common psychiatric presentation Pts with medical disorder at high risk for depression Occurs in children, adolescents, adults and older adults

Cultural Considerations Rate is lowest in Asians as compared to Caucasians, African Americans

& Hispanics

Depression

Heterogeneous, systematic illness involving an array of different neurotransmitters, neurohormones, & neuronal pathways

Biological: Genetic link Biochemical: Neurotransmitter abnormalities can probably cause

depression Serotonin: regulator if sleep, appetite & libido Norepinephrine: decreased levels can result in anergia (lack energy)

anhedonia (inability to find meaning or pleasure) decreased concentration & decreased libido

Neuroendocrine: evidence of increased cortisol secretion Image Findings: CAT & MRI show ventricular enlargement,

cortical atrophy, & sulcal widening

Theory

Cognitive Theory Developed by Aaron T. Beck Applied CBT to depression Proposed that people acquire psychological predisposition to

depression through early life exp Becks Cognitive Triad

A negative self-depreciating view of self A pessimistic view of world A belief that negative reinforcement will continue

Learned Helplessness Seligman (1973) stated that although anxiety is initial response

to stress, anxiety is replaced by depression if person feels no control over outcome

Theory

Major Depressive Disorder Defined as 1 or more major depressive episodes and

no history of manic or hypomanic episodes Subtypes

Psychotic features Catatonic features Melancholic features Postpartum onset Seasonal features Atypical features

Depressiove disorders

Dysthymia DisorderChronic depressive syndrome usually present for

most day, more days than not, for at least 2 yrsEarly and insidious onsetDepressive mood disturbance cannot be

distinguished from person’s usual pattern of functioning

Age of onset is usually early childhood and teenage years to early adulthood

Depressive disorders

Assessment Undiagnosed & untreated depression often associated with more severe presentation

of depression, greater suicidality, somatic problems, & severe anxiety Assessment Tools

Beck Depression Scale, Hamilton Depression Scale, Geriatric Depression Scale Assessment of Suicide Potential Areas to Assess

Mood, physical changes, cognition Assessment Guidelines Diagnosis: risk for suicide Outcomes Identification: Goal for safety Planning

Application of the nursing process

ImplementationCommunication GuidelineHealth Teaching and PromotionMilieu TherapyPsychotherapy: CBT and Behavioral therapyGroup: widespread modality for treatmentPharmacological/Biological/Integrative: ECT,

Antidepressant drugs (SSRI’s, TCA, Atypical, MAOs)

Application of nursing process

Somatic Treatments Electroconvulsive therapy (ECT) Vagus Nerve Stimulation

Integrative Therapies Light Therapy St. John’s Wort Exercise Future Treatment

Transcranial Magnetic Stimulation Brain Imaging

Evaluation Short term indicators and outcome criteria are frequently

evaluated

Application of the nursing process